52 msfocusmagazine.org MS Focus continues to advocate for access to healthcare for individuals with MS. I was invited to participate in the We Work for Health Summit hosted by Pharma, Inc. in Washington, D.C., July 18-19. More than 100 advocates from throughout the U.S. converged on Capitol Hill to let Congress members know how proposed changes to Medicare Part B and Part D could negatively affect those with MS and other chronic diseases. Some of the changes could increase out-of-pocket expenses for Medicare recipients. One proposal would switch reimbursement forsomedrugsthatarecoveredunderMedicare Part B to Medicare Part D. This would affect certain medications, including those currently administered in an office setting – such as an infusion center – which includes some of the disease-modifying therapies for MS. The cost of these drugs are less under part B because the price is negotiated by the providers administering them. The cost of these medications would increase for individual use if changed to Part D, and individuals would be responsible for more out-of-pocket expense for these medications. Therefore, they would enter the so called “donut hole,” or gap between their coverage and payment responsibility sooner. They would have to lay out the cost of these medications until they reach eligibility for catastrophic coverage. In addition, there are concerns about how these drugs would be administered. Instead of going to an infusion center and having medication administered on the spot, individuals might have to go pick it up at the pharmacy and then take it to their doctor’s office. One of the most controversial proposals is a new rule allowing private Medicare insurance plans, also known as Medicare Advantage plans, to require individuals to try cheaper drugs,beforetheycanreceiveamoreexpensive medication prescribed forthem bytheirdoctor. This is known as step therapy or “fail first” therapy. This change is slated to begin in 2019. It has physicians and patient advocacy groups concerned that this rule could affect the quality of care for Medicare recipients, who would not be allowed to be treated by a medication chosen by their physician for their condition. Before an individual would receive the preferred medication prescribed for them, they would have to go through an appeals process with their plan. Although this policy is designed to reduce drug costs, it is likely to have a greater affect on the healthcare system by increasing healthcare costs for hospitalizations and follow-up care. For example, if you have MS and your doctor prescribes a disease-modifying treatment MS Focus Activities Working for Access to Quality Cost-Effective Care by Natalie Blake